Individual
MR. KYLE J KEELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2206-B WEST MAIN, HWY 82, CLARKSVILLE, TX 75426
(903) 427-1545
(903) 427-0078
Mailing address
4005 LAMAR AVENUE, PARIS, TX 75462-5212
(903) 785-3861
(903) 739-8768
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1040384
TX
225100000X
Physical Therapist
2640
OK
2251S0007X
Sports Physical Therapist
1040384
TX
2251X0800X
Orthopedic Physical Therapist
Primary
1040384
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058545701
—
TX
05
—
100675670B
—
OK
01
—
120502
SUPERIOR PROVIDER NUMBER
—
01
—
5385104
AETNA PROVIDER NUMBER
—
01
—
80812T
BCBS PROVIDER NUMBER
TX
Enumeration date
06/08/2006
Last updated
04/04/2016
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